Broken trust: A history of atrocities

A conversation with emergency physician Italo Brown

Through his own family experiences, emergency medicine physician Italo Brown, MD, has seen what happens when health care fails. His mother, a high school English teacher, had deep respect for intellectual pursuits and encouraged him to consider becoming a physician.

Yet she struggled with sarcoidosis, obesity, diabetes and high blood pressure. A few years ago, his father drove her to the hospital and literally scooped her out of the car, in full respiratory arrest. She died soon after.

His father, a firefighter, mistrusted health care and physicians, attitudes engendered by the Tuskegee syphilis study — a medical experiment conducted between 1932 and 1972 on Black men with syphilis who were told they were receiving treatment but were not.

For Brown, the medical establishment was always stark and confounding. It was seen as valuable, yet it was filled with inequities.

Brown, an assistant professor of emergency medicine at Stanford, is the leader of Stanford’s effort to incorporate learning materials that advance the principles of equity and social justice into the medical school curriculum.

He is a change agent from within the medical world, hoping to start new doctors off free of racist preconceptions, and to build Black people’s trust in the medical profession.

Accomplishing that, he knows will not come easy because of America’s history of medically abusing Black people. Brown spoke with contributing editor Paul Costello about what ails the nation’s health care system in the eyes of many Black Americans. This Q&A was condensed and edited from that conversation.

Emergency physician Italo Brown said he hopes to help new doctors start off free of racist preconceptions, and he's working to build Black people’s trust in the medical profession. (Photo by Italo Brown)

Costello: Tell me about the name Italo. 

Brown: It’s West African and means valor. It was a self-fulfilling prophecy to name me something like courage or valor and then have to grow into it. For many years, it was fun to tell people what my name meant, but once they figured it out, the expectations also grew.

Costello: Growing up, what meaning did health care and medicine have in your family?

Brown: Health care in my family was always a tug of war. I remember as a child going to the doctor and thinking, “Oh, man, this is interesting, but I don't see any guys that look like me.”

To understand it and pursue it was championed and welcomed, but the ability to appreciate wellness and live under those certain tenets was not fully understood.

On the one hand, health care was this perceived goodness, and on the other, in the delivery of it, you saw how inequitable it was. That’s the same struggle our community faces.

“Health care in my family was always a tug of war. I remember as a child going to the doctor and thinking, “Oh, man, this is interesting, but I don't see any guys that look like me.”

Costello: The notorious Tuskegee experiment on Black men in Alabama left an indelible mark on generations of Black Americans. When did you first hear about it?

Brown: My dad told me about the Tuskegee syphilis study when I was a teenager. His mistrust of physicians was born out of its legacy. I understood it better when I went to Morehouse College and we talked about it in my public health classes.

I really found myself being the voice against this atrocity when I was in graduate school studying public health at Boston University. I was having a conversation with a young doctor, citing the Tuskegee study as one reason her Black patients probably didn’t trust her recommendations. She turned to me and said, “Then we need to have more people like you inside, because I care about these patients.”

Costello: Does Tuskegee still effect you?  

Brown: I definitely still feel a chill from it. I think about it often because these were men probably around my age watching their bodies go through something they didn’t understand. They trusted wholeheartedly that the right things were occurring.

The cruelty is something that I really wrestle with because the hope was to find answers to advance science. … Why does that have to happen at the detriment of folks who are marginalized and vulnerable? I wrestle with that as a person who wants medical science to advance but also wants the communities where I come from to be honored, respected and treated like human beings.

Costello: You must hear a lot, “Why can’t they just get over it?”

Brown: That’s a resounding sentiment. Just in terms of COVID-19, you’re hearing, “The vaccine is available; why is it not penetrating communities of color at the same rate as other communities? … You’ve got to put this behind you and just move forward.”

Actually, no we don’t. This is something that needs to be addressed. You can’t continue to act as though it didn’t happen. Sweeping it under the rug doesn’t give anyone a feeling of true justice. It doesn’t instill trust. It actually deepens mistrust.

There is a resting desire in our community to be able to have this opinion and for it to be validated simply by our existence. Literally saying, “I, like anyone else, can question. I, just like anyone else, can ask for sources and answers and be included in the conversation as a true stakeholder.”

“You can’t continue to act as though it didn’t happen. Sweeping it under the rug doesn’t give anyone a feeling of true justice. It doesn’t instill trust. It actually deepens mistrust.”

Costello: To not be dismissed?

Brown: Yes, to not be dismissed. Maybe when that happens, and it happens at a high enough clip, frequently enough on all issues, you’ll start to see that equity comes out. It’s not just this lopsided picture where all of a sudden, we’re in the middle of a pandemic and you want all Black people to just lay down their shields and say, “All right, go ahead and stick me with a needle.” That is not going to work. 

Costello: I’ve heard you say, “I am a river to my people.” Tell me what that means for you?

Brown: It’s a phrase from Lawrence of Arabia. I learned it from Will Smith. It means to be somebody who, with everything that you get, everything that you receive, you flood it to the communities that you come from, to the people who have no access to it. To be a reservoir, a tributary, is living up to your ultimate potential.

At the beginning of the pandemic, it became real to me that there was a vast disconnect between accurate information and what my community was receiving. That’s why it’s important to me to be a river to one’s people. It’s a constant reminder of why I’m in the health care space — because tons of people sacrificed, died, prayed and invested for me to be able to do this.

Costello:Your father was hesitant to get the vaccine. Can you tell me about that?

Brown: My dad is a Black man from the civil rights era. He never really trusted medicine. We got into some very heated debates around COVID-19 and the vaccine. Navigating that taught me how you have to have patience when speaking with not just people from the Black community, but people from older generations, too.

There’s a certain degree of reverence you should have towards people who have life experiences. As health care providers, we need to spend intensive time on this. “What are your apprehensions? What is your information gap? What would make you feel OK?”

It took weeks of dedicated conversations. My Dad is going to get the vaccine. He changed his mind.

“It’s important to me to be a river to one’s people. It’s a constant reminder of why I’m in the health care space — because tons of people sacrificed, died, prayed and invested for me to be able to do this.”

Costello: On a scale of 1 to 10, what is the level of mistrust in the Black community for medicine and health care?

Brown: Around 7, and that’s an improvement from what it was. Honestly, we’ll never be below a 3 or 4. Atrocities happened. James Marion Sims, a gynecologist who performed experiments on enslaved Black women; the 1910 Flexner Report, which closed down more than half of the Black medical schools in the United States; and Tuskegee. Forgive but not forget tends to be the model in our communities.

The medical community almost acts as though these things didn’t happen and continues to gaslight the community. To move that number starts with restorative justice. 

Paul Costello is the Stanford Medicine magazine contributing editor in the Office of Communications. Email him at paul.costello@stanford.edu.

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